Intra-operative Postperfusion Micronephrolithotomy for Renal Allograft Lithiasis: A Case Report.

Increasing demand drives the expansion of criteria for kidney donation, and nephrolithiasis is now considered a relative contraindication. We report for the first time a case of intra-operative, postperfusion kidney allograft micronephrolithotomy. A 64-year-old man with end-stage renal disease secondary to Alport syndrome underwent primary deceased donor kidney transplantation at our center. Pre-operative ultrasound of the donor identified a 7-mm calculus in the anterior, lower pole calyx. The kidney was extra-peritoneally implanted in the right iliac fossa and reperfused homogenously. Stone retrieval with a flexible ureteroscope failed due to the narrow calyceal infundibulum. Instead, the calculus was removed using the micropercutaneous nephrolithotomy system under ultrasonographic guidance. The calyx was punctured using a 4.85 Fr needle and the stone was fragmented to dust using a Holmium laser. No bleeding was observed. The post-operative course was uneventful. Outpatient follow up demonstrated good function of the graft which was stone free on ultrasound. Postperfusion micropercutaneous nephrolithotomy for kidney allograft calculi offers a safe and feasible option when pre-operative or intra-operative retrograde intrarenal surgery fails.

Desarrollo y validación de una herramienta de entrenamiento y evaluación para la nefrectomía radical laparoscópica / Development and validation of a training and assessment tool for laparoscopic radical nephrectomy

Introducción: La nefrectomía radical laparoscópica (NRL) es un pilar en el tratamiento del cáncer renal y las pequeñas masas renales. El entrenamiento quirúrgico del siglo XXI enfrenta desafíos, por lo tanto debe ser eficiente y seguro para que los cirujanos logren habilidades relevantes, protegiendo a los pacientes y los resultados operativos. Este estudio tuvo como objetivo desarrollar sistemáticamente una herramienta para capacitación y evaluación en NRL y validar la herramienta desarrollada para su uso por los urólogos en formación. Métodos: Este estudio prospectivo, longitudinal y multiinstitucional se realizó entre septiembre de 2014 y junio de 2015. Se utilizó el Análisis Modal de Fallos y Efectos de Salud para el desarrollo y luego se validó, donde la herramienta de evaluación se distribuyó a cinco especialistas para aumentar la validez del contenido. Cuatro expertos fueron observados como un enfoque multiinstitucional. Se consideraron los abordajes asistidos por la mano, transperitoneales y retroperitoneales. Resultados: La herramienta de evaluación NRL constó de cuatro fases, 17 procesos, 41 subprocesos. Se observaron cuatro cirujanos y equipos operativos en cuatro hospitales durante 19,5 h (5,75 h asistidas por la mano, 8,75 h transperitoneales, 5 h retroperitoneales). Después del análisis de riesgos, se construyeron tres listas de verificación. Las de NRL asistida manualmente y NRL transperitoneal contenían cuatro fases, 20 procesos, 33 subprocesos y la de NRL retroperitoneal contenía cuatro fases, 20 procesos, 30 subprocesos. Estos se fusionaron para formar una herramienta de evaluación. El resultado final fue una herramienta de evaluación de NRL de cuatro fases con 17 procesos, 41 subprocesos. Todos los participantes estuvieron de acuerdo en que la herramienta final de evaluación de NRL incluía los pasos pertinentes. Conclusiones: La herramienta de evaluación de NRL se desarrolló utilizando el análisis de riesgos Análisis Modal de Fallos y Efectos de Salud para garantizar que se incluyan los subpasos de procedimientos peligrosos. La validación aseguró que los procesos importantes no fueron pasados por alto. Se debe llevar a cabo una aplicación completa a través de un estudio piloto

Introduction: Laparoscopic radical nephrectomy(LRN) is a cornerstone in managing renal cancer and small renal masses. Twenty-first century surgical training faces challenges, thus must be efficient and safe so surgeons attain relevant skills, protecting patients and operative outcomes. This study aimed to systematically develop a tool for training and assessment in LRN and validate the developed tool for use by trainee urologists. Methods: This prospective, longitudinal, multi-institutional study was undertaken from September 2014 - June 2015. Healthcare Failure Mode and Effect Analysis was utilised for development and followed by validation where the assessment tool was distributed to five specialists to increase content validity. Four experts were observed as a multi-institutional approach. Hand-assisted, transperitoneal and retroperitoneal approaches were considered. Results: The LRN Assessment Tool comprised four phases, 17 processes, 41 sub-processes. Four surgeons and operating teams were observed across four hospitals for 19.5 hours (5.75 h hand-assisted, 8.75 h trans-peritoneal, 5 h retro-peritoneal). After hazard analysis, three checklists were constructed. Those for hand-assisted LRN and transperitoneal LRN contained four phases, 20 processes, 33 sub-processes and that for retroperitoneal LRN contained four phases, 20 processes, 30 sub-processes. These were merged to form one assessment tool. The final result was a four phase LRN Assessment Tool with 17 processes, 41 sub-processes. All participants agreed the final LRN Assessment Tool included pertinent steps. Conclusions: The LRN Assessment Tool was developed using Healthcare Failure Mode and Effect Analysis risk analysis to ensure hazardous procedural sub-steps were included. Validation ascertained important processes were not overlooked. Full application through a pilot study must be undertaken

Development and validation of a training and assessment tool for laparoscopic radical nephrectomy. / Desarrollo y validación de una herramienta de entrenamiento y evaluación para la nefrectomía radical laparoscópica.

INTRODUCTION: Laparoscopic radical nephrectomy(LRN) is a cornerstone in managing renal cancer and small renal masses. Twenty-first century surgical training faces challenges, thus must be efficient and safe so surgeons attain relevant skills, protecting patients and operative outcomes. This study aimed to systematically develop a tool for training and assessment in LRN and validate the developed tool for use by trainee urologists. METHODS: This prospective, longitudinal, multi-institutional study was undertaken from September 2014 - June 2015. Healthcare Failure Mode and Effect Analysis was utilised for development and followed by validation where the assessment tool was distributed to five specialists to increase content validity. Four experts were observed as a multi-institutional approach. Hand-assisted, transperitoneal and retroperitoneal approaches were considered. RESULTS: The LRN Assessment Tool comprised four phases, 17 processes, 41 sub-processes. Four surgeons and operating teams were observed across four hospitals for 19.5hours (5.75h hand-assisted, 8.75h trans-peritoneal, 5h retro-peritoneal). After hazard analysis, three checklists were constructed. Those for hand-assisted LRN and transperitoneal LRN contained four phases, 20 processes, 33 sub-processes and that for retroperitoneal LRN contained four phases, 20 processes, 30 sub-processes. These were merged to form one assessment tool. The final result was a four phase LRN Assessment Tool with 17 processes, 41 sub-processes. All participants agreed the final LRN Assessment Tool included pertinent steps. CONCLUSIONS: The LRN Assessment Tool was developed using Healthcare Failure Mode and Effect Analysis risk analysis to ensure hazardous procedural sub-steps were included. Validation ascertained important processes were not overlooked. Full application through a pilot study must be undertaken.

[Therapeutic patient education in chronic hand dermatitis]. / Éducation thérapeutique du patient dans l'eczéma chronique des mains.

Hand dermatitis (HD) is usually due to a combination of various interacting factors. It involves significant impairment of the quality of life with psychological and socioeconomic impact. A therapeutic education program in HD.was elaborated by 19 health professionals (dermatologists, occupational clinical physicians, nurses, psychologists, environmental medical advisor) with experience in therapeutic education or skills in HD, according to the recommendations of Haute Autorité de Santé. The program includes an individual medical consultation to perform educational diagnostic, two collective workshops and a medical evaluation consult. Two group workshops "the disease, irritant factors and its treatments" and "the experiences and feelings" were elaborated with learning objectives and educative tools. Different scores were proposed to evaluate the program and acquired skills. Therapeutic education is an efficient way to help patients to adopt skin protection measures essential to healing. We propose a guideline of therapeutic education in HD including skills and educative tools and intended for health professionals to serve as working basis.

[Cutaneous leishmaniasis]. / Leishmanioses cutanées.

Leishmaniasis is a group of parasitic conditions due to a flagella protozoan of the Leishmania genus and transmitted to man by phlebotomine sandflies. Cutaneous leishmaniasis exists all over the world. Those of the Old World are, in the vast majority of cases, purely cutaneous and spontaneously regress in several weeks to several months. In general, local treatment is sufficient. Those of the New World, due to multiple leishmaniasis complexes, involve a major risk of developing into a secondary mucosal form when rapid means of identifying the genus are not available. First-line treatment consists of antimony derivatives. In endemic regions, prophylaxy remains essential.